Home based care of palliative patients in Karachi: first experience from Pakistan

According to world health report 2010, 63% of deaths were due to non-communicable diseases.1 Cancer is the 2nd leading cause of death worldwide. Pakistan, like other countries is facing a double burden of diseases with incidence of 1.4 million per year.2 Dyspnea and lack of wellbeing 70%3 are the common symptoms among palliative patients followed by; pain 64%, anorexia 34%, and constipation 32%.4 People over 65 years of age are less likely want to die at home than younger people.5 Objectives: To determine the needs of Palliative patients visited at home in Karachi. Material and methods: A prospective cross sectional Pilot study was conducted on 50 patients visited at home in Karachi. Patients who had incurable diseases and labeled as Do-Not-Resuscitate were included. Patients with short visits for procedures were excluded. Data was collected by Principal Investigator on proforma after taking informed verbal consent. Mean was calculated for qualitative variable (age) and frequency was calculated for quantitative variables. Results: Mean age was 68.5 years, 64% were females. HTN was found in 80%, DM 64%, stroke 30% and cancers 26%. 72% were bedridden, 32% were on NG feed, and 6% on TPN. 52% were catheterized out of these silicon was inserted in 46%. Pain was found in 68% and Bed sores in 24%. Neurology was most common referring specialty in 28%. Most patients were presented with UTI 40%, LRTI 22%, Pain 48%, and constipation 30% and 90% were managed at home. Conclusion: Palliative patients have multiple needs like mobility, nutrition need, symptom management, psychological support. Healthcare providers need awareness and proper training in palliative care so that they can manage these issues at home. Key words: Palliative care, Pain, Bed sore, Outcom